Donor aid and research funding for newborn babies and preventing stillbirths
Authors: Philippa F Middleton
Journal: The Lancet Global Health (2023)

Two innovative and detailed papers from the London School of Hygiene & Tropical Medicine1Kumar MB Bath D Binyaruka P Novignon J Lawn JE Pitt C Donor aid mentioning newborns and stillbirths, 2002–19: an analysis of levels, trends, and equity.Lancet Glob Health. 2023; 11: e1785-e1793Summary Full Text Full Text PDF Google Scholar, 2Agravat P Loucaides EM Kumar MB et al.Research funding for newborn health and stillbirths, 2011–20: a systematic analysis of levels and trends.Lancet Glob Health. 2023; 11: e1794-e1804Summary Full Text Full Text PDF Google Scholar throw many challenges to donors, recipients, and researchers. We are reminded that almost all (98%) newborn deaths and stillbirths occur in low-income and middle-income countries. With universal coverage of quality maternal and newborn care, 3 million lives (mothers, newborns, and stillbirths) could be saved each year.3WHOEvery Newborn Action Plan progress report 2019.https://www.who.int/publications/m/item/every-newborn-progress-report-2019Date: March 1, 2020Date accessed: September 29, 2023Google Scholar Clearly, we are a long way off this target, even though solutions are available or potentially available. Using Muskoka2 methods, Megan Bruce Kumar and colleagues1Kumar MB Bath D Binyaruka P Novignon J Lawn JE Pitt C Donor aid mentioning newborns and stillbirths, 2002–19: an analysis of levels, trends, and equity.Lancet Glob Health. 2023; 11: e1785-e1793Summary Full Text Full Text PDF Google Scholar have shown that only 10% ($1·6 billion) of reproductive, maternal, newborn, and child health funding mentioned newborns and stillbirths. This allocation is disproportionately low relative to the actual neonatal mortality burden of over 2 million deaths a year and stillbirth burden of 2 million deaths per year. Some of the funding not explicitly allocated to newborns and stillbirths (eg, for maternal health) would probably help prevent stillbirths and neonatal deaths, although the extent of this is difficult to ascertain. More than 90 countries have now adopted Every Newborn Action Plans, and effective and equitable financial support is crucial. However, aid mentioning newborns and stillbirths stagnated by 2019, with most of the aid mentioning newborns and stillbirths (87%; $13·7 billion) being disbursed by just ten official development assistance or private grants. Domestic funding might exceed external aid, but this is difficult to track and hard to assess. Some countries might not prioritise, or have sufficient capacity, to use aid funding to help save lives of newborns and to prevent stillbirths. The second paper2Agravat P Loucaides EM Kumar MB et al.Research funding for newborn health and stillbirths, 2011–20: a systematic analysis of levels and trends.Lancet Glob Health. 2023; 11: e1794-e1804Summary Full Text Full Text PDF Google Scholar analyses research grants relating to newborns and stillbirth. 93% ($537 million) of funding (ie, that from major funders 2019–20 and all research funding allocated to low-income and middle-income countries 2011–20) was allocated to organisations based in high-income countries, who used the funding to support mostly preclinical or observational studies in low-income and middle-income countries. Investment in stillbirth research has been minimal in both high-income and low-income settings. Nonetheless, the total annual active funding for research related to newborn health or stillbirths almost tripled, from $23·5 million in 2011 to $68·2 million in 2020. In 2019–20, 550 new grants worth $577·1 million were awarded for newborn health or stillbirth research. Most funders were based in the USA and UK. Using the Dimensions information system, Priyesh Agravat and colleagues2Agravat P Loucaides EM Kumar MB et al.Research funding for newborn health and stillbirths, 2011–20: a systematic analysis of levels and trends.Lancet Glob Health. 2023; 11: e1794-e1804Summary Full Text Full Text PDF Google Scholar showed that only 20% of the funding for both small and vulnerable newborn research and stillbirth research was for interventional studies, with less than 5% funding for implementation research. It is possible for effective interventions to be implemented, such as improved nutrition and attention to infection, pollution, and substance use.4Hofmeyr G Black R Rogozińska E et al.Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes.Lancet. 2023; 401: 1733-1744Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar These two papers illustrate major inequities in both donor-aid allocation and research targeted to improve newborn care and stillbirth prevention. These data are, sadly, in line with other reports, particularly on the continuing failure to prioritise stillbirth. Mensa Abrampah and colleagues' 2023 review of global stillbirth5Mensah Abrampah NA Okwaraji YB You D et al.Global stillbirth policy review—outcomes and implications ahead of the 2030 Sustainable Development Goal agenda.Int J Health Policy Manag. 2023; 127391Crossref Scopus (0) Google Scholar shows gaping holes in stillbirth policies and data collection, and the 2020 UN report on the global burden of stillbirths6United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)A neglected tragedy: the global burden of stillbirths. United Nations Children's Fund, New York2020Google Scholar estimates that there will be 20 million stillbirths before 2030. Children who die within the first 28 days of birth suffer from conditions and diseases associated with paucity of quality care at or immediately after birth and in the first days of life. Approximately 6700 newborn babies died every day in 2019, amounting to 47% of all child deaths under the age of 5 years, up from 40% in 1990. In 2020, 2·4 million children died in the first month of life.7WHO. Newborn Mortality Fact Sheet, 28 Jan, 2022.Google Scholar However, strategies such as increased investment in preventative interventions, increased health workforce and global targets, and appropriately targeted donor funding could significantly reduce the number of stillbirths and neonatal deaths. The way forward in research funding is not so clear. Ideally, the amount of funding would match burden, and intervention and implementation funding for stillbirth prevention would be prioritised, not just by the health sector but also by society.8Mohiddin A Semrau KEA Simon J et al.The ethical, economic, and developmental imperative to prevent small vulnerable newborns and stillbirths: essential actions to improve the country and global response.Lancet. 2023; 401: 1636-1638Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar I am a Chief Investigator on the Australian National Health and Medical Research Council Stillbirth Centre of Research Excellence, and I report several stillbirth-related grants and funding from the Australian Department of Health and Aging. Research funding for newborn health and stillbirths, 2011–20: a systematic analysis of levels and trendsAlthough investment in research related to neonatal health and stillbirths has increased between 2011 and 2020, there are marked disparities in distribution geographically, between major causes of mortality, and among research pipeline types. Stillbirth research received minimal funding in both high-income countries and LMICs, despite a similar number of deaths compared with neonates. Direct investment in LMIC-led research, especially for implementation research, could accelerate the slow global progress on stillbirth prevention and newborn survival. Full-Text PDF Open AccessDonor aid mentioning newborns and stillbirths, 2002–19: an analysis of levels, trends, and equityAid mentioning newborns and stillbirths is poorly matched to their corresponding mortality burden (representing 10% of aid for reproductive, maternal, newborn, and child health overall, yet accounting for approximately 50% of mortality in children <5 years) and across recipient countries (with substantial variation in the amount of aid received per newborn death and stillbirth between countries with similar health and economic needs). Our findings indicate that aid needs to be better targeted to populations with the highest mortality burdens, creating greater potential for impact. Full-Text PDF Open Access